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April Legislative Update

OPA Participates in NACDS RxIMPACT Day on Capitol Hill
Ernest Boyd, PharmD (Hon), CAE

The Ohio Pharmacists Association led the charge on Capitol Hill during the March 9 and 10 “RxIMPACT Day.” Pharmacists, and pharmacy students from Ohio Northern University and the University of Toledo, visited Ohio’s members of Congress, and discussed two important issues:  the new MTM legislation (sponsored in the Senate by Ohio’s Sherrod Brown), and the need to be sure that pharmacies are properly reimbursed for generic drugs under Medicaid.  As you recall, CMS last year was going to cut reimbursement on generic drugs to 40 to 60 percent BELOW a pharmacy’s COST for these drugs.  We spoke loudly that that cannot happen to our pharmacies. 

I want to thank the many students who attended, including Brian Donaldson, from ONU, who took notes during each meeting for my “team.”  OPA Director of Government Affairs Kelly Vyzral headed up another team, as did Deirdre Myers, R.Ph. of ONU.  We made a strong impact on the legislators and staff whom we talked to about these issues.  We appreciated that this visit was organized by NACDS, and we’ll be participating in NCPA’s Legislative Day on the Hill in May. 

First, I’d like to give you an overview of what happened during several of these visits.  We had a personal meeting with Congressman Steve Austria, and even more time with his health care legislative aide (LA), Jessica Talbert.   She was very knowledgeable about health care reform and was very aware of issues facing health care.  She asked questions about PBM services and AWP, in addition to the MTM topics.  When Congressman Austria came in, he indicated that his vote will likely depend on the bill’s financial score, which will be calculated in the near future. 

We also were pleased to meet personally with Congressman Jim Jordan.  He was very supportive of pharmacy issues.  His Legislative Aide, Randee Olney, also spent much time with us.  She was new to the idea of MTM and was very interested in the personal stories that our students shared with her.  She seemed to genuinely approve of the idea of MTM.  We then met with Bethany Peck, Congressman Bob Latta’s Senior LA.  We gave her a brief rundown of the topic and handed her a packet of information.  We then met with Steve Chabot’s legislative correspondent, Christyn Keyes.  She was very interested to learn about MTM and the legislation. We hope that he will be a co-sponsor, but again, it will depend on the score of the bill.  Last was Andrew Sigmon, Congressman Michael Turner’s LA.  Turner’s office was very busy, but we had a good meeting with Andrew and he was really interested in the student perspective of the bill.  He also inquired about the score of the bill, but said he would definitely bring the information to Turner’s attention.

Here is the information we conveyed to Congress. Feel free to use any of this language if you get a chance to speak with any of them. 

Medicare Therapy Management

Pharmacist-provided services such as medication therapy management (MTM) are an important tool in the fight to improve medication use by the public. MTM helps to prevent medication errors, ensures medication compliance and gets patients and caregivers more involved in medication therapy. In one study, for every $1 invested in MTM programs, overall health care costs were reduced by $12. (Journal of the American Pharmacists Association, March-April 2008). In the North Carolina “Checkmeds” program, MTM helped 31,000 seniors optimize their drug therapy, resulting in estimated savings of $34 million – a return on investment of nearly 14 to 1. Congress recognized the importance of MTM on a bipartisan basis, including it as a required offering in the Medicare Part D benefit when it was created. We urge Congress to build on this earlier action, and strengthen the MTM benefit in Medicare Part D through support of “The Medication Therapy Management Empowerment Act.”

Legislative Summary

The Medication Therapy Management Empowerment Act (S. 274 and H.R. 891)

Improved Access. Under current restrictions, seniors must suffer from “multiple chronic conditions” and be prescribed “multiple medications” before they are eligible for MTM, limiting the benefit to only one quarter of Medicare beneficiaries. The legislation revises the eligibility criteria to include seniors who suffer from any chronic disease that accounts for high spending in the Medicare program, as well as first time dual-eligible beneficiaries and individuals in transitions of care. Expanding access to these high risk groups will help avert medication misuse and the huge costs that result.

Patient Choice. Currently, Medicare drug plans can restrict the locations where seniors receive MTM services. The bill will allow Medicare beneficiaries to use the pharmacy of  their choice, so long as the pharmacy has agreed to participate. This will make it more convenient for seniors to find MTM providers closer to home.

Payment and Quality. The bill will ensure that drug plans reimburse pharmacies and other qualified MTM providers based on the time and resources necessary to provide MTM care. There are well-established criteria used to set reimbursement rates for other Medicare providers, and this will ensure that payments are set to attract a sufficient number of qualified MTM providers to serve seniors.

Fair and Accurate Medicaid Reimbursement

Congress has long debated how to reimburse pharmacies fairly and accurately for generic drugs dispensed to Medicaid patients, attempting to strike a balance between fiscal soundness and maintaining incentives for pharmacies to drive down costs by dispensing generic drugs, which benefits the entire health care delivery system. The Deficit Reduction Act of 2005 (DRA) required the use of average manufacturer price (AMP) to set maximum payment limits for pharmacies for generic drugs in Medicaid. Multiple government studies found the formula created by DRA would result in below cost reimbursement to pharmacies for many generic medications. Clearly, this would have reduced access to pharmacy services and cost-effective prescription medications and been devastating to low income Americans and the pharmacies that serve them.

In addition, as Congress considers making changes to the health care reform law, we ask lawmakers to keep in place these important changes to ensure that patients continue to have access to cost-effective prescription drugs and professional service from their trusted neighborhood pharmacies.


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